Have news about HIV? Send press releases, news tips and other announcements to news@poz.com.

August 1, 2007

Salome’s Secret

Blueberries! Prison gangs! Rat brains! Iron-tongued orator Ashley Mack has a genius for picking topics that land her in the championships of the cutthroat college speech-and-debate circuit. But the 2007 Arizona State University grad says that when it came time to pick her senior speech theme, she was “torn.” Mack, now 22, had long been drawn to the “rhetoric of HIV, rhetoric of silence around it, the rhetoric of stigma.” (She will specialize in the rhetoric of HIV as she starts graduate work this fall at the University of Texas.) But she also knew that even for the academic, supposedly progressive judges who would decide her fate at 10 tournaments throughout the school year, some topics were just too “polarizing.” Still, the gender-studies major was determined to be true to her passion: women’s sexual empowerment and safety, and their right to a microbicide or gel that would help them protect themselves against HIV. And so she began her research, trying to find an idea that would fit snugly into the official rules for collegiate informative speaking: “An original, factual speech by the student on a realist subject to fulfill the general aim to inform the audience. Audio-visual aids may or may not be used to supplement and reinforce the message. Multiple sources should be used and cited in the development of the speech. Minimal notes are permitted. Maximum time is 10 minutes.”

The result, which we print below in slightly adapted form, is “Salome’s Secret”—which won the national championship. In ruthless factual detail, the speech traces a frustrating irony long familiar to the HIV scientific community but utterly new to most of the young audiences and speech professors who heard Mack deliver it some 50 times from October 2006 through April 2007. The “secret” involves a potentially cure-promising HIV immunity that, Mack contends, is a moralistic U.S. government’s worst funding nightmare. Her own judges’ comments, she notes, often hovered somewhere between “stigma and utter disbelief. The judges would write on the ballot that they just couldn’t believe that sex workers could be immune to HIV—and that if they ‘hadn’t heard of it, how could it possibly be true?’ They also were made uncomfortable by the suggestion that sex workers should be studied to help find a larger cure.” Despite initial poor rankings, Mack persisted in the competitions, eventually qualifying for the national finals in April, where she finished first out of a thousand challengers. (Second place went to a speech on the Arab Al-Jazeera news network.) Mack plans to continue to bring the story of Salome’s Secret to new audiences; she also teaches aspiring high-school orators to use HIV topics in their local tournaments. And as the undergrad college crowd begins to prepare their orations for the upcoming scholastic season, Mack’s success has put HIV back in vogue. Through all the accolades, Mack wants to make one point clear to all who didn’t see her presentation. “I didn’t speak from notes!” she says, aghast at the question. “That’s so bush league.”

The following is “Salome’s Secret,” Ashley Mack’s national championship speech:

In Majengo, the largest slum in the Kenyan capitol of Nairobi, prostitution is as prevalent as poverty. Indeed about 80% of the women who sell sex in Kenya are believed to be infected with HIV. Amid the chaos of Nairobi, in a 5-by-5-foot tin shack, 45-year-old sex worker Salome Simon stands as a bit of an anomaly. A 25-year veteran of sex work, Salome has slept with over 50,000 men. She maintains that she has never used contraceptives or medication, and is—to this day—unable to contract HIV. And she is not alone.

In 1981, when Americans were first discovering that video would kill the radio star (and that a mysterious virus was killing gay men in New York and San Francisco), Dr. Frank Plummer and a team of researchers from the University of Manitoba traveled to Nairobi to study sexually transmitted diseases. By 1988, they had stumbled onto about 500 female sex workers who seemed resistant to HIV despite constant exposure to the virus. Since then, over 1,000 sex workers from Majengo have fallen under the microscope for their bizarre immunity, referred to as Salome’s Secret.

Evolutionary viruses like HIV make cultivating a vaccine ridiculously difficult. Yet these women are doing in nature what scientists have never accomplished in labs. So why has Salome’s Secret remained a secret among most of the mainstream press, world governmental AIDS funders and the scientific community? On a continent ravaged by poverty and AIDS, the existence of long-term immunity is tantalizing and hopeful. The fact that no one is talking about it: shocking.

Each day, Salome Simon sits on a stool outside her spearmint-colored shack and waits for business to knock at her door. The shack has two beds, one pink and grandiose (for her personal use), and the other, which Simon jokingly refers to as “the office,” hard and plain. For years, she watched as other prostitutes sickened and died and wondered why nothing was happening to her. Scientists also wondered, and the results of the Majengo study can be analyzed in two areas: genetic links and genital tracts.

At first, immunologists researched blood make-up and T cells, and found genetic links between many of the immune prostitutes. After a failed vaccine trial, however, researchers discovered that while being related greatly increased the likelihood of developing the resistance, many relatives, including Salome’s daughter, who was not a prostitute, were still dying of AIDS.

Next, researchers were shocked when an immune sex worker’s blood sample was directly exposed to HIV, and the virus wasn’t rebuffed. This proved that the resistance was located outside of the bloodstream, forcing them to shift the focus of their research—and conclude that the key to the sex workers’ immunity actually resides in their vaginas. Their vaginas secrete special proteins which suppress and annihilate the HIV virus before it ever enters the bloodstream. The proteins are produced by a white blood cell called the Human Leukocyte Antigens, or HLA. Everybody has HLAs; they fight off foreign invaders such as bacteria. But the proteins produced by the sex workers are unlike anything seen before.

Still more astonishing, according to a BBCnews.com report on March 1, 2007, when these women take time off from sex work, they “suffer a sharp fall in their immune responses.” Several of the immune prostitutes have contracted HIV upon resuming business. In a personal interview on March 17, 2007, Dr. Frank Plummer, the director of research for the project, has said that the women are “best protected when their systems are being constantly challenged. When there is nothing to fight, the defenses come down.”

Raised in Bukoba, a small town in Tanzania, Salome first joined sex work when her husband left her. As she explains, “I had my children to feed; what else was I supposed to do?” But that was over two decades ago. Why haven’t we discovered the source of Salome’s Secret after all this time? For one thing, it was only recently that the pace and urgency of the Nairobi research begun to accelerate. At first, the study was in the dark ages, hampered by archaic research facilities and poor funding. This was a result of many factors, including the U.S. antiprostitution-pledge requirement, which makes getting U.S. funds for research involving sex work virtually impossible. It was only recently, with multimillion-dollar private donations from the Bill & Melinda Gates Foundation and Britain’s Wellcome Trust, that new laboratories dedicated to the study were opened.

But this new money and interest doesn’t mean that answers will come easily. The peasant culture embedded in Kenya is nomadic; women regularly drop out of the project and move to other towns, making them a hard sample to study. The irregularity of the sample population has stretched out the research process, making answers really difficult to come by.

Finally, Plummer explains, the greatest challenge has been the “acceptance of the idea that these women are actually resistant to HIV infection. Not all people believe it.” These women seem to counter everything we’ve ever been taught about HIV and abstinence as the only prevention. Researchers are thus given the unenviable task of defeating 20 years of social conditioning. In addition, many researchers, including Dr. Elizabeth Ngugi from the University of Nairobi, are wary about the way researchers are using the women. Dr. Ngugi contends that instead of teaching them to protect themselves, or encouraging them to get out of sex work, researchers are gambling with their health in order to test their hypothesis. But Dr. Plummer argues, “We cannot make them get out of sex work, and in reality this is how many of them choose to live.” Also, trying to “fix” them, or “educate” them can be culturally offensive.

The most likely application for future results of this research would be the creation of a microbicide gel. If we can capture how the sex workers produce the proteins that extinguish HIV, a vaginal gel could replicate the behavior. Such a gel would be used only by women—placing the burden of responsibility solely on their shoulders but also empowering them to take control of their bodies in a way they haven’t been able to before.

As HIV and AIDS have been viewed so often in the past as punishments for sexual deviance, how ironic it is that our salvation might come in the form of sex work. As Bill Gates once proclaimed, until we reduce stigma, the “world [will be] fighting AIDS with its hands over its eyes.” Perhaps by creating discourse about the women in Majengo, and what they are capable of, we can finally begin to reduce that stigma.

Salome is still alive and kicking—alive and working—and so Plummer’s research goes on. He says it’s important to believe in the possibilities of research. Perhaps in Salome’s small shack in the slums of Nairobi, we can unlock the secret that everyone has been dying to hear.

This special report is based on research by Ashley Mack. Queries should go to: mackspeech@gmail.com

(Note: The POZ team reviews all comments before they are posted. Please do not include either ":" or "@" in your comment. The opinions expressed by people providing comments are theirs alone. They do not necessarily reflect the opinions of Smart + Strong, which is not responsible for the accuracy of any of the information supplied by people providing comments.)